Evidence-based ethics--what it should be and what it shouldn't.
BACKGROUND
The concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a systematic analysis and explication of the term and its applicability in ethics important.


CONCLUSIONS
In this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings.


CONCLUSIONS
The use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data.
Strech
Daniel
D
Institute of Medical Ethics, University of Tübingen, Schleichstrasse 8, 72076 Tübingen, Germany. daniel.strech@uni-tuebingen.de
D003657:Decision Making / Q000941:ethics*; D036262:Empirical Research; D026690:Ethics, Clinical; D004992:Ethics, Medical; D019317:Evidence-Based Medicine / Q000941:ethics; D006801:Humans; D012196:Review Literature as Topic